NDC codes

FDA NDC Directory
Product NDC (as listed)59365-5030Labeler and product segments. Claims need a package NDC.
Product NDC at billing width59365-5030Add the package segment from the table below.
Package NDCs as listed with the FDA, and the 11-digit 5-4-2 form used on claims. The highlighted digit is the added leading zero.
Package NDC11-digit (billing)PackageCopy
59365-5030-059365503000113.4 g in 1 TUBE (59365-5030-0)Marketed from Apr 1, 1977

How the 11-digit form is made: The package segment has 1 digit, so one leading zero is added to it (5-4-1 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules

Product information

Brand name (proprietary)
Trimo San
Generic name (nonproprietary)
oxyquinoline sulfate and sodium lauryl sulfate
Active ingredients
Oxyquinoline sulfate — .25 mg/gSodium lauryl sulfate — .1 mg/g
Dosage form
Jelly
Route
Vaginal
Product type
Prescription drug
Marketing category
Unapproved drug (other)
Marketing start
Marketing end
Identifiers
Product ID 59365-5030_545cdcec-f36b-451d-92be-8a4b21e70719SPL ID 545cdcec-f36b-451d-92be-8a4b21e70719SPL set ID 1e4a1caa-e6ba-44ef-8347-07e6385a7c9eRxCUI 999638, 999640UNII 61VUG75Y3P, 368GB5141J

Billing references

What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.

HCPCS codeNo match

No drug-specific HCPCS code in Med-Code's directory for this product. The directory is curated and not complete — check the current CMS HCPCS file before billing.

NDC on a medical claim

N459365503000 followed by a unit qualifier and the quantity

Package 59365-5030-00. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier

Product label

Current FDA label (SPL), effective .

Full label on DailyMed (opens in a new tab)

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